Normal Function of the Sinuses

The sinuses, or more properly, “Paranasal Sinuses”, are air filled spaces connected to the nasal passages.

There are 4 sets of sinuses on each side of the nose:
Frontal (above the eyes)
Maxillary (below the eyes and above the teeth)
Ethmoid (between the eyes)
Sphenoid (at the very back of the nasal passage, in the center of the head).

The exact purpose of the sinuses is not known for certain, but all mammals have them. They may provide more surface area to produce mucus in the nose for moisturization of inhaled air, or they may simply be present to lighten the weight of the head.

During normal function, small glands in the lining of the sinuses produce mucus which is constantly being moved out of the sinuses by microscopic waving fingers or “cilia” on the surface of the cells lining the sinus cavities. These cilia sweep the mucus along a constant pathway directed to the opening of the sinus cavity that drains into the nasal airway. This passageway, called the sinus “ostium,” is normally relatively narrow, only several millimeters in diameter.

When the mucus in the sinus is flowing normally, it constantly sweeps out any bacteria that may get into the sinus cavity and prevents the bacteria from becoming too numerous. If the mucus cannot get out, the bacteria in the sinus could be allowed to multiply before they are removed and become an infection.

Chronic Sinusitis

Chronic sinusitis, which is caused by narrowing of the normal sinus drainage pathways, can cause nagging facial pain and pressure, headache, nasal obstruction, postnasal drip, ear pressure, and contribute to a general feeling of poor health

Treatment for Chronic Sinusitis

Treatment for chronic sinusitis is directed at opening the drainage pathways enough that the sinuses can once again clear themselves and resume normal function.

Medical Therapy

The first step in this process is to use aggressive medical therapy with a prolonged course of antibiotics; 4 weeks at least. Frequently, antibiotics are taken with other medications to reduce swelling in the nose and sinuses such as nasal steroids, systemic steroids (pills), and possibly other treatments such as allergy treatment. If this course of medical therapy eliminates the problem for good then that is all that needs to be done.

Surgical Therapy

If the symptoms of chronic sinusitis do not resolve completely, or if they get better and come back after an aggressive course of medical therapy, then it may be necessary to move to the next step of enlarging the drainage pathways directly.

Endoscopic Sinus Surgery (ESS) or Balloon Sinuplasty

Endoscopic Sinus Surgery (ESS) entails putting a patient under general anesthesia in the operating room and using tools to cut out portions of the sinus drainage pathways in order to remove the blockage. While Endoscopic Sinus Surgery still has a role occasionally, in the last few years, new technology called “Balloon Sinuplasty” has now replaced Endoscopic Sinus Surgery in most cases.

Balloon Sinuplasty

We can now restore sinus drainage by simply using a small balloon to stretch open the narrowed passages. This can be done by numbing up the nose in the office, requires no cutting, and can be done in about 30-40 minutes.  

At Alamogordo ENT, we are one of 3% of practices nationwide that offer in-office IV sedation to assure complete comfort during the procedure. If a patient chooses this option, IV sedation is administered by a Certified Anesthetist. 

Since offering Balloon Sinuplasty, we have been very gratified to observe that our patients have had improvement in symptoms at least as good, and possibly BETTER than, those seen with traditional ESS. This may be due to the fact that the anatomy of the sinuses after the procedure is more “physiologic”, or closer to normal, than with more invasive surgery, AND we can actually treat more of the sinuses. 

 Also, recovery with Balloon Sinuplasty is much quicker than with ESS.  Many patients report marked improvement in their pre-surgery symptoms within a few days, and the symptoms related to surgical swelling are much less than with ESS and resolve much more quickly.